This collection of charts and a related brief explore a number of different metrics used to look at health outcomes, quality of care, and access to services. Inconsistent or unavailable data and imperfect metrics make it difficult to firmly judge system-wide health quality in the U.S., but a review of the data we do have suggests that the system is improving across each of these dimensions, though it continues to lag behind comparably wealthy and sizable countries in many respects.
Bench-marking U.S. quality measures against those of similarly large and wealthy countries is one way to assess how successful the U.S. has been at improving care for its population, and to learn from systems that often produce better outcomes. The OECD has compiled data on dozens of outcomes and process measures. Across a number of these measures, the U.S. lags behind similarly wealthy OECD countries (those that are similarly large and wealthy based on GDP and GDP per capita).In some cases, such as the rates of all-cause mortality, premature death, death amenable to healthcare, and disease burden, the U.S. is also not improving as quickly as other countries, which means the gap is growing.
Mortality rates have fallen steadily in the U.S. and in comparable countries
Gauging the quality of health care systems is often difficult and restricted by the availability of data. One method for measuring quality is to look at mortality rates. Mortality rates can be influenced by a myriad of factors, one of which is the quality of the health care system for diseases where mortality is amenable to health care. The mortality rate (number of deaths per 100,000 people, adjusted for age differences across countries) has been falling in the U.S. and in comparable countries.
The U.S. has the highest rate of deaths amenable to health care among comparable countries
Researchers have looked at mortality that results from medical conditions for which there are recognized health care interventions that would be expected to prevent death. While the health care system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively health care is being delivered. In 2006, the last year for which reasonably complete information is available, the U.S. had the highest mortality rate for deaths amenable to health care among the comparable countries.
Potential Years of Life Lost have fallen steadily in the U.S. and in comparable countries
The U.S. and comparable OECD countries have made progress in reducing PYLL’s over the last thirty years, although the U.S. continues to trail the comparable country average by a significant margin (4584 v. 2765 PYLLs per 100,000 population in 2013).
Disease burden is higher in the U.S. than in comparable countries
Disability adjusted life years (DALYs) are a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death. Though DALYs have declined in the U.S. and comparable countries since 2000, the U.S. continues to have higher age-adjusted rates than those of comparable countries.
Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries
Hospital admissions for certain chronic diseases like circulatory conditions, asthma, and diabetes, can arise when prevention services are either not being delivered or adhered to. Hospital admission rates in the U.S. are higher than in comparable countries for congestive heart failure, asthma, and complications due to diabetes. However, the U.S. has lower rates of hospitalization for hypertension than comparably wealthy countries do on average.
30-day mortality for heart attacks and ischemic stroke are lower in the U.S. than in comparable countries
Mortality within 30 days of being discharged from a hospital stay is not entirely preventable, but can be reduced for certain diagnoses and services. Improvement in this area is often linked to improved quality of care. The 30-day mortality rates for heart attacks (acute myocardial infarction) and ischemic strokes (caused by blood clots) are lower in the United States than in comparable countries. The 30-day mortality rate after hospital discharge for hemorrhagic stroke (caused by bleeding) is similar in the U.S. to comparable countries.
The U.S. has higher rates of medical, medication, and lab errors than comparable countries
According to an international survey by the Commonwealth Fund, the U.S. has higher rates of medical, medication, and lab errors than comparable countries. This includes medical mistakes, incorrect medications or dosages, lab test errors, or delays receiving abnormal test results.
Similar rates of retained surgical items in the U.S. compared to other countries
The frequency with which surgical items are retained or fragments of surgical devices are un-retrieved from the patient is higher in the U.S. than in some comparable countries, but lower than others.
Post-op clots are better in the U.S. than in some comparable countries
Another way to measure the quality of the health care system is to ensure patients are receiving recommended care without additional harm. Post-operative pulmonary embolisms or deep vein thrombosis are more prevalent in the U.S. than in comparable countries.
Post-op sepsis are better in the U.S. than in some comparable countries, but not as low as others
Post-operative sepsis less prevalent in the U.S. than in Australia and the United Kingdom, but more common than in Switzerland.
Post-op suture ruptures are worse in the U.S. than in comparable countries
Post-operative suture ruptures more prevalent in the U.S. than in other comparable countries such as Australia, Switzerland, and the United Kingdom.
Obstetric trauma during vaginal delivery is less common in the U.S. than some comparable countries
Obstetric trauma during vaginal delivery happens more frequently in the U.S. than in some comparable countries, but lower than other. The U.S. has the lowest occurrence of trauma in deliveries without instruments.
Five-year survival rates for certain cancers are higher in the U.S. than in comparable countries
The five-year survival rates for breast cancer and colorectal cancer in the U.S. are higher than in comparable countries, but the survival rate for cervical cancer is slightly lower. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is often assessed through five-year survival rates. The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient. One study also found that while the U.S. outperforms comparable countries on survival rates for breast and colorectal cancer, this is not the case for all cancers, including lung cancer.
Mortality rates for breast and colorectal cancer in the U.S. are lower than in comparable countries
While there is debate over the best way to measure outcomes for cancer, the U.S. typically performs better in both mortality rates and five-year survival rates for breast and colorectal cancer. In 2013, the mortality rate for breast cancer in the U.S. was slightly better than the comparable country average. During the same period, the comparable country average (22.1%) was about 32% higher in the mortality rate for colorectal cancer than the U.S. (16.8%).
The mortality rate for cancers has been falling in the U.S. and across comparable countries
The mortality rate for all cancers (neoplasms) has fallen in the U.S. and in comparable countries over the last 30 years. In the U.S., the age-adjusted cancer rate has fallen from about 262 deaths per 100,000 population in 1980 to about 206 per 100,000 in 2013.
Mortality rates for diseases of the circulatory system have fallen dramatically over the last 30 years
The U.S. and other countries have made dramatic progress in lowering mortality from diseases of the circulatory system. In the U.S., the mortality rate has fallen from 629 deaths per 100,000 population in 1980 to 253 in 2013.
The mortality rate for respiratory diseases is higher in the U.S. than in comparably wealthy countries
Mortality rates for respiratory diseases have fallen over the last 10 years in the U.S. and across comparable countries.
Mortality rates for endocrine, nutritional and metabolic diseases have fallen over the last 15 years
After rising significantly between 1985 and 1995, mortality rates for these disease have fallen steadily, although the remain substantially higher than the average rate in comparable countries.
Use of the emergency department in place of regular doctor visits is more common in the U.S. than in most comparable countries
According to a recent international survey by the Commonwealth Fund, patients in the U.S. visit the emergency department for conditions that could have been treated by a regular doctor or place of care nearly twice as often as in comparable countries.
Adults in most comparable countries have quicker access to a doctor or nurse when they need care
According to a recent international survey by the Commonwealth Fund, with the exception of Canada, the U.S. has longer waits for an appointment when patients are sick and need care than comparable countries.